A Pressure Without Pain: Early Detection of Silent Glaucoma Using Optical Coherence Tomography

Abla Almalik¹, Asim Ahmed², Davide Rinaldi

Abstract

Glaucoma remains one of the leading causes of irreversible blindness worldwide. Early detection is essential because significant retinal nerve fiber layer damage may occur before visual symptoms appear. This diagnostic accuracy study assessed the ability of optical coherence tomography (OCT) to detect early glaucoma in asymptomatic individuals.

A total of 842 adults undergoing routine eye examinations were included. OCT measurements of retinal nerve fiber layer thickness and ganglion cell complex were analyzed. Early glaucoma was confirmed in 214 participants (25.4%).

The OCT-based detection model achieved sensitivity of 86.3% and specificity of 88.1%, with an area under the ROC curve of 0.91. Patients with RNFL thickness <82 µm had a 4.7-fold increased risk of early glaucoma.

The study demonstrates that OCT screening can detect structural optic nerve damage before clinical symptoms develop, emphasizing the importance of incorporating imaging-based screening programs into routine ophthalmic practice.